P-498 Can Working With Pneumotoxic Medication Lead to Pulmonary Fibrosis in Health Workers? A Case of Pulmonary Fibrosis After a Career With Daily Handling of Bleomycin

Abstract Introduction Bleomycin, an antitumor antibiotic used to treat malignancies, causes interstitial pulmonary fibrosis in 10% of patients receiving high cumulative dosages intravenously. Bleomycin is a model chemical to induce lung fibrosis in experimental animals. Intralesional injection bleomycin is also used in dermatology to treat recalcitrant warts (without evidence of lung toxicity to the patients). Methods A 67-year-old man was referred for pulmonary fibrosis. He was a smoker for about 20 years (1/2 pack/day, cessation in 1990) with an unremarkable medical history, except for arterial hypertension and reflux oesophagitis. He mentioned a slow deterioration of his physical ability and coughing without other respiratory complaints, except for a single episode of haemoptysis and an asymptomatic COVID infection. Results HRCT was compatible with nonspecific interstitial pneumonia, showing subpleural reticulation, thickened interlobular septa and ground-glass opacities mainly in posterobasal areas. Lung function showed normal volumes but a decreased diffusing capacity (DLco 65% predicted). Common causes of pulmonary fibrosis (including autoimmune disease, hypersensitivity pneumonitis) were excluded. He had recently retired after a 25-year career as a dermatologist in private practice, during which he had treated, almost every day, patients with warts with intralesional injections of bleomycin using jet injectors. He prepared and administered the medication himself, without taking safety precautions against the inhalation of small droplets generated by the pneumatic jet injection. He is estimated to have handled about 90 mg of bleomycin per year. Discussion and conclusion This unique case suggests that repeated occupational exposures to small amounts of airborne bleomycin in dermatological clinical practice may lead to lung fibrosis.